Appeals Court Gives Insurers a CSR Win, but Limits Payout

August 24

Health insurers that sued to recoup halted cost-sharing reduction (CSR) payments scored a key victory on Aug. 14 when a federal appeals court confirmed that the government must reimburse them for providing subsidies to low-income Affordable Care Act exchange enrollees. But that win came with a significant catch, as the three-judge panel said insurers can collect only the monetary damages that they didn’t already recoup from silver loading — the process by which they raise benchmark silver-plan premiums to compensate for lost CSR payments.

Health policy experts who spoke to AIS Health say they don’t expect the court’s decisions will cause much to change about CSRs or silver loading, as the current setup is working well for nearly all stakeholders. Still, insurers probably won’t file any more lawsuits seeking CSR reimbursement from the 2018 plan years and beyond, since they aren’t likely to collect any damages.

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Health Plan Weekly

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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